How is Sweden doing it? Perhaps more accurately, what is "it" that Sweden is doing? Can we do it too? Should we? It's really hard to say. Sweden has been both praised and condemned for it's unusual approach to the coronavirus pandemic. It's lack of mask mandates, lockdowns. and school closures are source of envy or dismay depending on your outlook. I'm not going to spend a lot of of time exploring Sweden's approach. There are quite a few good articles that do that and I've included links to some of them here. (This article weighs whether Sweden's COVID policy was a disaster or object of admiration. And this one examines some of Sweden's unique features that make it a "special case.") The one thing that's clear is that's its not really clear whether Sweden's approach is effective or not. As such Sweden becomes the perfect canvas for us to project our deepest hopes or darkest fears about what is (or isn't) the ideal way to combat this virus.
What I will do is share a few interesting numbers comparing the United States and Sweden. First I should point out how I came to start thinking about Sweden in the first place today. I was skimming through the New York Times database of global cases and deaths. I was curious as to which nation had the slowest spread of the virus. To my surprise, Sweden was third from the slowest, with only the tiny nation of Luxembourg and the evening tinier city-state, Vatican City spreading the virus more slowly. Amazing! Furthermore, only 0.8% of the population (about 84,000) have been infected with the virus, compared with the United States, where 1.8% of the population has been infected. And while the virus is still spreading in the United States, in Sweden it seems to have come to a standstill. Sweden has a population of 10,000,000--fewer people than the state of Ohio, and it's had 40,000 fewer infections. This is Sweden's success story. COVID-19 is just not spreading aggressively in this country despite it's lax approach to restrictions. Oh, it sounds like a dream!
But there is a dark side to Sweden's story as well. Though the nation has fewer people than Ohio and the virus has not spread as far or as rapidly, the Swedes have still suffered almost 2,000 more COVID-19 deaths than Ohio has. Furthermore, the percentage of their population that has died from the virus is exactly the same as the United States (albeit a small percentage, 0.06% to be precise). Sweden is losing the same percentage of its population as the world leader in deaths. When you look at the percentage of Swedes who tested positive for the virus who ended up dying, the picture is even more bleak. In Sweden 6.9% of those who tested positive ended up dying, while in the U.S. 3.% of those who tested positive ended up succumbing to the disease. Granted, as elsewhere in the world most of those who died were elderly (and these days its quite popular with many in the supposedly pro-life crowd to shrug those deaths off--they were gonna die anyway, right?). But it's interesting that in Sweden, the restrictions are light, the spread is slow, but man--if you get it, you're in trouble (But you probably won't get it).
I'm wondering though if I've been looking at this all wrong. I wrote the above last night, but this morning as I read over what I'd written again, I realized that maybe Ohio is exactly the right comparison for Sweden. Perhaps it makes more sense to compare nation to state instead of nation to nation. When we do that, Sweden doesn't look like such an outlier. 40,000 fewer cases is not huge, not when Florida has 623,000 cases, 500,000 more cases than Ohio but only about 10,000,000 more people. Likewise a difference of 2,000 deaths is not that great either. Maybe the answer is simply that Sweden's unique characteristics such as the high number of single person households and lower population density, led to a slightly lower and slower spread despite the lack of restrictions. And likewise Sweden has slightly more deaths than Ohio due to also to the lack of the same restrictions. Sweden's unique factors balance out it's unique approach resulting in essentially a wash. Perhaps Sweden is not so special after all. When you put it all together perhaps Sweden ends up being more or less, like Ohio. What's also clear to me given the Swedish advantages, they could have done a lot better. I'm no expert, but maybe this is the solution to the Swedish Conundrum.
Meanwhile, back in the United States, yesterday, Monday, August 31, we crossed the six million case mark with 6,041,885 total cases. It took only a day longer than I predicted to get to this number. I project we'll hit seven million total cases by September 21. Of this total, 113,865 are new cases in the past three days and this number is about 41,000 fewer than I predicted. Deaths have reached 183,450 in total with 1,766 new deaths in the previous three days. This number was also less than I predicted by about 2000. It's also worth noting that for the first time ever the rate of increase for deaths dropped below 1% (just barely, at 0.997% ). What I think we are seeing is a plateau developing in the United States for the number of cases (that's what what the New York Times seven-day average graph shows as well). Unfortunately, the numbers are plateauing at a much higher level than they did in late May and early June. The American case story appears to be a first wave followed by settling at a higher plateau, followed by another wave and another still higher plateau. That appears to be the case with the nation as a whole, but the story with individual states is a little different as we shall see.
What I wonder about is what is happening with deaths. Yesterday's number of new deaths in a three day period are almost exactly the same as on June 20. Just ball-parking the numbers, it appears that the U.S. COVID death rate has stayed fairly consistent since it's spring peak when we saw over 12,000 deaths in the U.S. in a three day period. We've not approached anything like those highs since, not even through this summer's explosion of new cases. This could be the template for the coming months, ever higher waves and plateaus of cases, with a steady thrum of deaths ranging from two to four thousand every three days. Extrapolating outwards that could mean anywhere from 243,000 to 487,000 deaths from COVID by next March, which would account for 10 to 20% of the total deaths from all causes in that time frame (using 2017 data here, for comparison). This would make COVID-19 the third leading cause of death in the United States right behind heart disease and cancer. Of course a big question mark is what hospitalization rates have looked like and what the prognosis is for those that get COVID and recover. How many bounce back to completely normal; how many deal with long-lasting and even life-long issues from the disease? Since I didn't track that data I can't really say.
As for my final prediction for the Dispatch from Coronaville series, I project that by Thursday, September 3 we will have 6,156,680 total cases in the United States and 185,261 total deaths.
The states present an interesting picture. It's hard to tell what's happening. They could be plateauing or they could be in a slow decline. If our new cases are plateauing then Florida and Ohio will reflect what I seem to be seeing with the U.S. as a whole--a new plateau that's higher than the one in late spring and early summer. Nebraska on the other hand appears to be plateauing below the spring high case counts. You just can't tell what's happening when you're in it. Only in hindsight is the pattern clear. Everybody's down this time around but again, that's neither here nor there unless a general pattern becomes clear over time.
Total Cases
Florida: 623,463 total cases, 2.8% of the population.
Ohio: 123,157 total cases, 1.1% of the population.
Nebraska: 34,046 total cases, 1.7% of the population.
Deaths are different story in each state. Florida has yet to return to it's pre-summer new death counts--and it's too soon to say if the state will get back there. Right now yesterday's toll while lower than it's been since June, would still be the second highest number of new deaths had these numbers registered in April. Ohio meanwhile seems to reflect what's happening in the nation as a whole with deaths seeming to have plateaued at a much lower count than the highs of the spring. And a careful examination of Nebraska appears to reveal a similar pattern as well.
Total Deaths
Florida: 11,186, a rate of 1.8%
Ohio: 4,138, a rate of 3.4%. I think it's worth noting that Ohio's death rate is lower than Sweden's by more than half. That's sure evidence that Sweden's hands-off approach is not without a significant human cost.
Nebraska: 400, a rate of 1.2%
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